Credentialing Specialist I - Medical Staff

SUMMARY :

Verifies medical training, experience and other attributes required of medical health care providers. Ensures the completion of files and monitors expired documents during the members appointment period.

ESSENTIAL FUNCTIONS :

Assists Credentialing Specialists and Leadership with the credentialing and recredentialing process.

Reviews applications and other data for accuracy and completeness.

Performs and collects primary source verification and other documents needed including follow-up activities of initial and reappointments applications.

Enter credentialing and privileging data timely and accurately into the credentialing database.

Ensures good working relationships with clinical departments, Medical Staff leadership and professional agencies.

Assists in compliance with the accrediting and regulatory agencies regarding credentialing, while developing and maintaining a working knowledge of the required statutes and laws.

Answers phones, assist with committee support, make copies, prepare mailings, and maintain files.

• Adheres to TMCH organizational and department-specific safety, confidentiality, values, policies, and standards.

Performs related duties as assigned.

EDUCATION: High school diploma or general education degree (GED), or an equivalent combination of relevant education and experience.

EXPERIENCE : None required. One (1) year experience performing medical staff credentialing or similar related tasks preferred.

LICENSURE OR CERTIFICATION : None required.

KNOWLEDGE, SKILLS, AND ABILITIES :

• Knowledge and ability to understand what credentialing of medical health care providers entails.
• Knowledge and ability to understand, policy and procedures, regulations, statues, and laws as it relates to documents required for credentialing.
• Ability to organize and prioritize all assigned tasks and workloads in a busy work environment.
• Ability to brief leadership in a timely manner on status of workload, projects, priorities, barriers, or issues to ensure assignments are on track.
• Skill in the use of Microsoft Office products, especially Word and EXCEL.
• Ability to review and monitor various forms of detailed credentialing information to ensure compliance with departmental procedures.
• Ability to draft reports, business correspondence, and procedure manuals.
• Ability to respond professionally to departmental inquiries from internal or external customers in a timely manner. This includes understanding the escalation path for more complicated topics.